Job Description

Medical Director – Medicare Programs

Remote | Approx. $300,000 base + significant bonus potential

About the Opportunity:

A leading national healthcare contractor is seeking a Medical Director to provide clinical leadership and decision-making support for Medicare operations. This position plays a critical role in developing and enforcing coverage determinations, reviewing complex claims, and promoting evidence-based medical policy. The role is ideal for a physician, especially those with a background in Physical Medicine and Rehabilitation (PM&R), who wishes to transition from direct patient care into a leadership position influencing medical necessity and healthcare compliance at scale.

Key Responsibilities:

• Clinical Leadership:
• Provide medical expertise for claim reviews, appeals, and Medicare policy development. Serve as a subject matter expert across multiple specialties.
• Policy Development:
• Collaborate with the Centers for Medicare & Medicaid Services (CMS) and other contractors to create, revise, and maintain Local Coverage Determinations (LCDs) and related guidance.
• Program Integrity:
• Identify trends in billing or compliance issues and work with investigative teams to address improper claims.
• Medical Review & Appeals:
• Oversee quality assurance in pre- and post-payment medical review determinations and assist with administrative law proceedings when necessary.
• Provider Education:
• Lead outreach and training for healthcare providers and professional associations to ensure adherence to Medicare policies and evidence-based practices.

Travel is minimal (approximately 3–4 weeks per year), and the position is fully remote with occasional in-person meetings or conferences.

Required Qualifications:

• MD or DO from an accredited institution.
• Active, unrestricted medical license in at least one U.S. state (must be eligible for additional licensure where required).
• Board Certification in a specialty recognized by the American Board of Medical Specialties (minimum three years).
• At least three years of experience as an attending physician.
• Prior experience within the Medicare, health insurance, or utilization review environment.
• Strong understanding of clinical evidence evaluation and medical necessity determination within fee-for-service structures.
• Excellent communication and collaboration skills across technical, regulatory, and clinical teams.
• Computer proficiency (MS Office, data analysis tools, virtual collaboration platforms).

Preferred Qualifications:

• Background in PM&R, Internal Medicine, Oncology, Radiology, Ophthalmology, or Infectious Disease.
• Five or more years of clinical practice experience.
• Prior experience as a Medical Director in a Medicare or commercial payer organization.
• Familiarity with HCPCS, CPT, and ICD-10 coding standards.
• Advanced degree or coursework in healthcare administration or systems management (MBA, MHA, MS).
• Experience performing systematic literature reviews or using GRADE methodology.

Compensation & Benefits:

• Base salary: Approximately $300,000, flexible depending on experience.
• Bonus structure: Significant performance-based bonuses.
• Benefits: Comprehensive health coverage, generous retirement contributions, paid time off, and strong professional development support.
• Schedule: Full-time, remote position with flexible hours.

Why Join:

This is an opportunity to move beyond clinical work while continuing to make a direct impact on patient access and policy integrity at a national level. Join a mission-driven organization that values medical expertise, promotes collaboration, and advances fairness and compliance within the U.S. healthcare system.

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